Home Health & Hospice Week

Home health agencies operating in Comprehensive Care for Joint Replacement Model areas can expect the bundling demonstration to influence their referrals and care planning for a longer period of time than first expected.

Then: The Centers for Medicare & Medicaid Services began the CJR model in 2016 and intended to end it in March 2020. “The CJR model holds participant hospitals financially accountable for the quality and cost of a CJR episode of care and incentivizes increased coordination of care among hospitals, physicians, and post-acute care providers,” CMS explains on its CJR webpage. “The episode of care begins with an admission to a participant hospital of a beneficiary who is ultimately discharged under MS-DRG 469 (Major joint replacement or reattachment of lower extremity with major complications or comorbidities) or 470 (Major joint replacement or reattachment of lower extremity without major complications or comorbidities) and ends 90 days post-discharge,” CMS says. “The episode includes all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries, with the exception of certain exclusions.”

Now: CMS has published a final rule in the May 3 Federal Register extending the demo three more years, through December 2024. CMS proposed the extension back in February 2020, as well as COVID-related changes and other program revisions in more regulations throughout the year.

CMS studies found “CJR model episode payments decreased by 3.7 percent more over the first 2 years of the CJR model. These decreases in payments have likely reduced Medicare program spending over the first 2 performance years of the model by an estimated $17.4 million (with a range of Medicare losses of $41.1 million to Medicare savings of $75.9 million, due to uncertainty in per episode savings),” the final rule notes.

Post-acute providers told CMS that due to “playing a key role in the CJR model, [they] should be offered the same financial incentives” as physician practices when it comes to gainsharing. “These commenters believe this proposal likely exacerbates disparate treatment of PAC providers in comparison to physicians regarding gainsharing payments,” the final rule says.

“We agree with the commenters that PAC providers play a key role in the CJR model,” CMS notes. But hospitals are free to make gainsharing arrangements with post-acute providers including home health agencies.

CMS did not take up some commenters’ suggestion to make gainsharing mandatory for hospitals, the rule notes. It also waved off a suggestion to suspend the post-acute transfer proration rule. CJR currently runs in 67 metropolitan statistical areas.

The rule is at www.govinfo.gov/content/pkg/FR-2021-05-03/pdf/2021-09097.pdf.